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Wang BK, Shubin AD, Harvey JA, MacConmara MM, Hwang CS, Patel MS, Vagefi PA. From Patients to Providers: Assessing Impact of Normothermic Machine Perfusion on Liver Transplant Practices in the US. J Am Coll Surg 2024; 238:844-852. [PMID: 38078619 DOI: 10.1097/xcs.0000000000000924] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 04/18/2024]
Abstract
BACKGROUND Normothermic machine perfusion (NMP) of livers allows for the expansion of the donor pool and minimization of posttransplant complications. Results to date have focused on both donor and recipient outcomes, but there remains potential for NMP to also impact transplant providers. STUDY DESIGN Using United Network for Organ Sharing Standard Transplant Analysis file data, adult deceased donors who underwent transplantation between January 1, 2016, and December 31, 2022, were identified. Transplanted livers were divided by preservation methods (static cold storage [SCS] and NMP) and case time (day-reperfusion 8 am to 6 pm ). Patient factors, transplant characteristics, and short-term outcomes were analyzed between Mahalanobis-metric-matched groups. RESULTS NMP livers represented 742 (1.4%) of 52,132 transplants. NMP donors were more marginal with higher Donor Risk Index scores (1.78 ± 0.50 NMP vs 1.49 ± 0.38 SCS, p < 0.001) and donation after cardiac death frequency (36.9% vs 8.4%, p < 0.001). NMP recipients more often had model for end-stage liver disease (MELD) exception status (29.9% vs 23.4%, p < 0.001), lower laboratory MELD scores (20.7 ± 9.7 vs 24.3 ± 10.9, p < 0.001), and had been waitlisted longer (111.5 [21.0 to 307.0] vs 60.0 [9.0 to 245.0] days, p < 0.001). One-year graft survival (90.2% vs 91.6%, p = 0.505) was similar between groups, whereas length of stay was lower for NMP recipients (8.0 [6.0 to 14.0] vs 10.0 [6.0 to 16.0], p = 0.017) after adjusting for confounders. Notably, peak case volume occurred at 11 am with NMP livers (vs 9 pm with SCS). Overall, a higher proportion of transplants was performed during daytime hours with NMP (51.5% vs 43.0%, p < 0.001). CONCLUSIONS NMP results in increased use of marginal allografts, which facilitated transplantation in lower laboratory MELD recipients who have been waitlisted longer and often have exception points. Importantly, NMP also appeared to shift peak caseloads from nighttime to daytime, which may have significant effects on the quality of life for the entire liver transplant team.
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Affiliation(s)
- Benjamin K Wang
- From the Division of Surgical Transplantation, Department of Surgery, University of Texas Southwestern Medical Center, Dallas, TX (Wang, Shubin, Harvey, Hwang, Patel, Vagefi)
| | - Andrew D Shubin
- From the Division of Surgical Transplantation, Department of Surgery, University of Texas Southwestern Medical Center, Dallas, TX (Wang, Shubin, Harvey, Hwang, Patel, Vagefi)
| | - Jalen A Harvey
- From the Division of Surgical Transplantation, Department of Surgery, University of Texas Southwestern Medical Center, Dallas, TX (Wang, Shubin, Harvey, Hwang, Patel, Vagefi)
| | | | - Christine S Hwang
- From the Division of Surgical Transplantation, Department of Surgery, University of Texas Southwestern Medical Center, Dallas, TX (Wang, Shubin, Harvey, Hwang, Patel, Vagefi)
| | - Madhukar S Patel
- From the Division of Surgical Transplantation, Department of Surgery, University of Texas Southwestern Medical Center, Dallas, TX (Wang, Shubin, Harvey, Hwang, Patel, Vagefi)
| | - Parsia A Vagefi
- From the Division of Surgical Transplantation, Department of Surgery, University of Texas Southwestern Medical Center, Dallas, TX (Wang, Shubin, Harvey, Hwang, Patel, Vagefi)
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Gouchoe DA, Ganapathi AM, Cui EY, Henn MC, Yim WY, Geng B, Whitson BA, Zhu H. Is Time Scheduling Important? An Analysis of Donor Heart Cross-clamp Times During Heart Transplantation. Transplant Direct 2024; 10:e1588. [PMID: 38529355 PMCID: PMC10962895 DOI: 10.1097/txd.0000000000001588] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/07/2023] [Revised: 12/19/2023] [Accepted: 12/29/2023] [Indexed: 03/27/2024] Open
Abstract
Background Outcomes in heart transplantation are affected by a variety of variables and patient factors. However, the impact of circadian rhythms, gene expression, and transcription remain underexplored. We thus evaluated the potential role of donor heart cross-clamp times on short-term and long-term outcomes after heart transplantation. Methods A total of 31 713 heart transplants were identified from the United Network for Organ Sharing Database. Patients were first stratified on the basis of time of donor procurement: 12 am to 12 pm or 12 pm to 12 am. To evaluate a possible effect of circadian rhythms, donor time was further divided into 5 groups based on preclinical data: 4 am to 8 am; 8 am to 11 am; 11 am to 5 pm; 5 pm to 10 pm; 10 pm to 4 am. Groups were assessed with comparative statistics. Long-term survival was evaluated using Kaplan-Meier methods and a multivariate Cox proportional hazard model. Results Patients who received hearts recovered between 12 am and 12 pm had significantly higher survival than those who received hearts recovered between 12 pm and 12 am. This survival difference was observed in both unadjusted (P = 0.002) and adjusted analyses (hazard ratio [HR]: 0.93; 95% confidence interval [CI], 0.89-0.97; P < 0.001). On unadjusted analysis, the survival difference among the 5 groups was insignificant (P = 0.07). Following adjustment, the periods of 11 am to 5 pm (HR: 1.09, 95% CI, 1.02-1.17; P = 0.012), 5 pm to 10 pm (HR: 1.11; 95% CI, 1.04-1.19; P = 0.002), and 10 pm to 4 am (HR: 1.07; 95% CI, 1.01-1.15; P = 0.034), were all independently associated with increased long-term mortality. Notably, the time of 8 am to 11 am was not associated with a change in survival (HR: 1.04; 95% CI, 0.96-1.14; P = 0.3). Conclusions Given the independent association of donor timing and survival after adjustment in a large national cohort, further investigation into the role of donor circadian rhythm and donor procurement time is warranted in preclinical and clinical studies. Understanding the underlying mechanisms of this observation could potentially lead to the development of effective treatments and donor procurement processes that prepare the organs for transplantation in a better condition.
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Affiliation(s)
- Doug A. Gouchoe
- Department of Surgery, The Ohio State University Wexner Medical Center, Columbus, OH
| | - Asvin M. Ganapathi
- Department of Surgery, The Ohio State University Wexner Medical Center, Columbus, OH
| | - Ervin Y. Cui
- Department of Surgery, The Ohio State University Wexner Medical Center, Columbus, OH
| | - Matthew C. Henn
- Department of Surgery, The Ohio State University Wexner Medical Center, Columbus, OH
| | - Wai Yen Yim
- Department of Cardiovascular Surgery, Union Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China
| | - Bingchuan Geng
- Department of Cardiovascular Surgery, Union Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China
| | - Bryan A. Whitson
- Department of Surgery, The Ohio State University Wexner Medical Center, Columbus, OH
- The Davis Heart and Lung Research Institute, The Ohio State University Wexner Medical Center, College of Medicine, Columbus, OH
| | - Hua Zhu
- Department of Surgery, The Ohio State University Wexner Medical Center, Columbus, OH
- The Davis Heart and Lung Research Institute, The Ohio State University Wexner Medical Center, College of Medicine, Columbus, OH
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Delman AM, Kassam AF, Turner KM, Ammann AM, Lynch C, Morris MC, Vaysburg DM, Cortez AR, Quillin RC. Incidence of attrition among early-career abdominal transplant surgeons. Surgery 2023; 173:1113-1119. [PMID: 36167700 DOI: 10.1016/j.surg.2022.08.017] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/08/2022] [Revised: 08/11/2022] [Accepted: 08/15/2022] [Indexed: 11/25/2022]
Abstract
BACKGROUND The prevalence of burnout and depression among abdominal transplant surgeons has been well described. However, the incidence of early-career transplant surgeons leaving the field is unknown. The objective of this study was to quantify the incidence of attrition among early-career abdominal transplant surgeons. METHODS A custom database from the Organ Procurement and Transplantation Network with encrypted surgeon-specific identifiers was queried for transplant surgeons who entered the field between 2008 and 2019. Surgeons who experienced attrition, defined as not completing a subsequent transplant after a minimum of 5, were identified. Surgeon-specific case volumes, case mix, and recipient outcomes were modeled to describe their association with attrition. RESULTS Between 2008 and 2018, 496 abdominal transplant surgeons entered the field and performed 76,465 transplant procedures. A total of 24.4% (n = 121) experienced attrition, with a median time to attrition of 2.75 years. Attrition surgeons completed fewer kidney (7 vs 21, P < .01), pancreas (0.52 vs 1.43, P < .01), and liver transplants (1 vs 4, P < .01) in their first year of practice. Attrition surgeons completed a smaller proportion of their transplant center's volume (9% vs 18%, P < .01) and were less likely to participate in pediatric transplants (26.5% vs 52.5%, P < .01) and living donor kidney transplants (64.5% vs 84.5%, P < .01). On multivariable analysis, performing fewer kidney (odds ratio: 0.98, 95% confidence interval: 0.98-0.99) and liver transplants (odds ratio: 0.98, 95% confidence interval: 0.97-0.98) by year 5 and completing a smaller proportion of their centers' volume (odds ratio: 0.96, 95% confidence interval: 0.94-0.98) were associated with attrition. Furthermore, attrition surgeons had worse allograft and patient survival for liver transplant recipients (both log-rank P < .01). CONCLUSION This investigation was the first to quantify the high incidence of attrition experienced by early-career abdominal transplant surgeons and its association with surgeon-specific case volumes, case mix, and worse recipient outcomes. These findings suggested the abdominal transplant workforce is struggling to retain their fellowship-trained surgeons.
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Affiliation(s)
- Aaron M Delman
- Cincinnati Research in Outcomes and Safety in Surgery Research Group, Department of Surgery, University of Cincinnati College of Medicine, OH. https://twitter.com/AaronDelman
| | - Al-Faraaz Kassam
- Cincinnati Research in Outcomes and Safety in Surgery Research Group, Department of Surgery, University of Cincinnati College of Medicine, OH. https://twitter.com/afkassam
| | - Kevin M Turner
- Cincinnati Research in Outcomes and Safety in Surgery Research Group, Department of Surgery, University of Cincinnati College of Medicine, OH. https://twitter.com/KevinTurnerMD
| | - Allison M Ammann
- Cincinnati Research in Outcomes and Safety in Surgery Research Group, Department of Surgery, University of Cincinnati College of Medicine, OH
| | - Caroline Lynch
- Cincinnati Research in Outcomes and Safety in Surgery Research Group, Department of Surgery, University of Cincinnati College of Medicine, OH
| | - Mackenzie C Morris
- Cincinnati Research in Outcomes and Safety in Surgery Research Group, Department of Surgery, University of Cincinnati College of Medicine, OH. https://twitter.com/MackMorrisMD
| | - Dennis M Vaysburg
- Cincinnati Research in Outcomes and Safety in Surgery Research Group, Department of Surgery, University of Cincinnati College of Medicine, OH. https://twitter.com/DMVaysburg
| | - Alexander R Cortez
- Cincinnati Research in Outcomes and Safety in Surgery Research Group, Department of Surgery, University of Cincinnati College of Medicine, OH. https://twitter.com/AlexCortezMD
| | - Ralph C Quillin
- Cincinnati Research in Outcomes and Safety in Surgery Research Group, Department of Surgery, University of Cincinnati College of Medicine, OH; Division of Transplantation, Department of Surgery, University of Cincinnati College of Medicine, OH.
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Trends in Surgeon Burnout in the US and Canada: Systematic Review and Meta-Regression Analysis. J Am Coll Surg 2023; 236:253-265. [PMID: 36519921 DOI: 10.1097/xcs.0000000000000402] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/23/2022]
Abstract
BACKGROUND Burnout among surgeons is increasingly recognized as a crisis. However, little is known about changes in burnout prevalence over time. We evaluated temporal trends in burnout among surgeons and surgical trainees of all specialties in the US and Canada. STUDY DESIGN We systematically reviewed MEDLINE, Embase, and PsycINFO for studies assessing surgeon burnout from January 1981 through September 2021. Changes in dichotomized Maslach Burnout Inventory scores and mean subscale scores over time were assessed using multivariable random-effects meta-regression. RESULTS Of 3,575 studies screened, 103 studies representing 63,587 individuals met inclusion criteria. Publication dates ranged from 1996 through 2021. Overall, 41% of surgeons met criteria for burnout. Trainees were more affected than attending surgeons (46% vs 36%, p = 0.012). Prevalence remained stable over the study period (-4.8% per decade, 95% CI -13.2% to 3.5%). Mean scores for emotional exhaustion declined and depersonalization declined over time (-4.1 per decade, 95% CI -7.4 to -0.8 and -1.4 per decade, 95% CI -3.0 to -0.2). Personal accomplishment scores remained unchanged. A high degree of heterogeneity was noted in all analyses despite adjustment for training status, specialty, practice setting, and study quality. CONCLUSIONS Contrary to popular perceptions, we found no evidence of rising surgeon burnout in published literature. Rather, emotional exhaustion and depersonalization may be decreasing. Nonetheless, burnout levels remain unacceptably high, indicating a need for meaningful interventions across training levels and specialties. Future research should be deliberately designed to support longitudinal integration through prospective meta-regression to facilitate monitoring of trends in surgeon burnout.
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5
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Vaysburg DM, Delman AM, Sisak S, Turner KM, Ammann AM, Cortez AR, Shah SA, Quillin III RC. Biophysiological stress and sleep deprivation among abdominal transplant surgery fellows: A prospective multi-institutional study using a wearable device. Am J Surg 2022; 225:962-966. [DOI: 10.1016/j.amjsurg.2022.11.004] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/29/2022] [Revised: 09/20/2022] [Accepted: 11/04/2022] [Indexed: 11/09/2022]
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Choubey AP, Bullock B, Hoste B, Ortiz A, Khan SA, Mishra A, Pearson T, Koizumi N, Ortiz J. Diversity in American Society of Transplant Surgeons Governance: Equitable but Unequal. EXP CLIN TRANSPLANT 2022; 20:973-979. [PMID: 34498553 DOI: 10.6002/ect.2021.0111] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/30/2022]
Abstract
OBJECTIVES The diversity in the governance of the American Society of Transplant Surgeons has not been described. We aimed to quantify the present state of its leadership as a baseline to inform future research. MATERIALS AND METHODS Lists of leaders on the American Society of Transplant Surgeons Council, the COVID-19 Strike Force, and 20 different American Society of Transplant Surgeons committees were obtained from the Society's website. Demographic and training information for the members were compiled through internet searches and analyzed. RESULTS The American Society of Transplant Surgeons Council included 15 members, with 20% women. It was 93.3% non-Hispanic White. The COVID-19 Strike Force included 12 surgeons, 16.7% of whom were female, with 75% non-Hispanic White. Of the 198 committee members, 23.7% were women, 68.7% were nonHispanic White, 16.6% were Asian, 8.1% were Hispanic, and 6.6% were Black. Among female committee members, underrepresented minorities comprised 23.6%. Committee chairs included 23% women, 23% underrepresented minorities, and 2.3% minority women. International medical graduates were more likely men (P = .02). CONCLUSIONS Representation of women in the American Society of Transplant Surgeons leadership has kept pace with their membership in the transplant surgery workforce. There is a deficiency of female under - represented minorities in leadership positions at the Society. Further interventions are required to recruit underrepresented minorities to transplant surgery, catalog their footprint in the workforce, and champion their role as leaders within the American Society of Transplant Surgeons.
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Affiliation(s)
- Ankur P Choubey
- From the Department of Surgery, University of Toledo Medical Center, Toledo, Ohio, USA
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7
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Bery A, Ali A, Cypel M, Kreisel D. Centralized Organ Recovery and Reconditioning Centers. Thorac Surg Clin 2022; 32:167-174. [PMID: 35512935 DOI: 10.1016/j.thorsurg.2021.11.003] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
An increased focus on improving efficiency and decreasing costs has resulted in alternative models of donor management and organ recovery. The specialized donor care facility model provides highly efficient and cost-effective donor care at a free-standing facility, resulting in improved organ yield, shorter ischemic times, decreased travel, and fewer nighttime operations. Ex vivo lung perfusion (EVLP) improves utilization of extended criteria donor lungs, and centralized EVLP facilities have the potential to increase transplant volumes for smaller transplant programs in specified geographic regions. These alternative models are increasingly being used in the United States to improve waitlist mortality and combat the ongoing donor organ shortage.
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Affiliation(s)
- Amit Bery
- Division of Pulmonary and Critical Care Medicine, Department of Medicine, Washington University School of Medicine, 660 South Euclid Avenue, Campus Box 8052, St Louis, MO 63110, USA.
| | - Aadil Ali
- Toronto Lung Transplant Program, Division of Thoracic Surgery, Department of Surgery, University Health Network, University of Toronto, Toronto General Hospital, 200 Elizabeth Street, 9N969, Toronto, Ontario M5G 2C4, Canada
| | - Marcelo Cypel
- Toronto Lung Transplant Program, Division of Thoracic Surgery, Department of Surgery, University Health Network, University of Toronto, Toronto General Hospital, 200 Elizabeth Street, 9N969, Toronto, Ontario M5G 2C4, Canada
| | - Daniel Kreisel
- Department of Surgery, Washington University School of Medicine, Campus Box 8234, 660 South Euclid Avenue, St Louis, MO 63110, USA; Department of Pathology & Immunology, Washington University School of Medicine, Campus Box 8234, 660 South Euclid Avenue, St Louis, MO 63110, USA
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8
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A Primer for Success as an Early Career Academic Plastic Surgeon. Plast Reconstr Surg Glob Open 2022; 10:e4066. [PMID: 35186625 PMCID: PMC8849379 DOI: 10.1097/gox.0000000000004066] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/09/2021] [Accepted: 11/24/2021] [Indexed: 11/26/2022]
Abstract
The early career academic plastic surgeon strives to be an expert surgeon, an innovative researcher, and an impactful educator. Navigating these challenges is difficult in a healthcare landscape with diminishing public research funding, increasing demand from institutions for clinical productivity, and decreased value of surgical education. To help the junior academic plastic surgeon, this article discusses the fundamental aspects of developing an early academic plastic surgery practice, rooted in clinical care, research, and education.
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9
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Yao H, Wang P, Tang YL, Liu Y, Liu T, Liu H, Chen Y, Jiang F, Zhu J. Burnout and job satisfaction of psychiatrists in China: a nationwide survey. BMC Psychiatry 2021; 21:593. [PMID: 34819029 PMCID: PMC8612106 DOI: 10.1186/s12888-021-03568-6] [Citation(s) in RCA: 16] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/19/2021] [Accepted: 10/26/2021] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Despite a significant shortage of psychiatrists in China, an ever-increasing number of psychiatrists in China are experiencing burnout and job dissatisfaction and considering leaving their jobs. Yet, to our knowledge, there have been no nationwide studies to date that examined both burnout and job dissatisfaction of psychiatrists in China. Therefore, this study evaluated burnout and job dissatisfaction of psychiatrists in China, and identified relevant characteristics. METHODS We conducted a nationwide, cross-sectional survey in March 2019. Psychiatrists from all tertiary psychiatric hospitals in China were invited to participate. The Maslach Burnout Inventory-Human Service Survey and the short version of the Minnesota Satisfaction Questionnaire were used to measure burnout and job satisfaction. Data on socio-demographic and occupational characteristics were collected. Multivariate logistic regression was conducted to identify socio-demographic and occupational characteristics associated with burnout and job satisfaction. RESULTS In total, 4520 psychiatrists from tertiary psychiatric hospitals in China completed the questionnaire. Overall, 38.4% of respondents met the criteria for burnout and 35.6% were dissatisfied with their jobs. Being male, more years of practice, having no leadership role, and longer working hours per week were significantly associated with burnout and job dissatisfaction. Lower monthly pay was significantly associated with job dissatisfaction but not burnout. Moreover, burnout was significantly associated with job dissatisfaction. CONCLUSIONS Our data suggest a high rate of burnout and job dissatisfaction among psychiatrists in China. In order to preserve and strengthen the mental health workforce, proactive measures are urgently needed to mitigate burnout and job dissatisfaction among psychiatrists in China.
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Affiliation(s)
- Hao Yao
- grid.16821.3c0000 0004 0368 8293Shanghai Clinical Research Center for Mental Health, Shanghai Key Laboratory of Psychotic Disorders, Shanghai Mental Health Center, Shanghai Jiao Tong University School of Medicine, Shanghai, 200030 China
| | - Peicheng Wang
- grid.12527.330000 0001 0662 3178Vanke School of Public Health, Tsinghua University, Beijing, 100084 China ,grid.12527.330000 0001 0662 3178School of Medicine, Tsinghua University, Beijing, 100084 China
| | - Yi-Lang Tang
- grid.414026.50000 0004 0419 4084Mental Health Service Line, Atlanta VA Medical Center, Decatur, GA 30033 USA ,grid.189967.80000 0001 0941 6502Addiction Psychiatry Fellowship Program, Department of Psychiatry and Behavioral Sciences, Emory University, Atlanta, GA 30329 USA
| | - Yuanli Liu
- grid.506261.60000 0001 0706 7839School of Health Policy and Management, Chinese Academy of Medical Sciences & Peking Union Medical College, Beijing, 100730 China
| | - Tingfang Liu
- grid.12527.330000 0001 0662 3178Institute for Hospital Management of Tsinghua University, Beijing, 100091 China
| | - Huanzhong Liu
- grid.459419.4Department of Psychiatry, Chaohu Hospital of Anhui Medical University, Hefei, 238000 China ,grid.186775.a0000 0000 9490 772XDepartment of Psychiatry, Anhui Psychiatric Center, Anhui Medical University, Hefei, China
| | - Yanhua Chen
- grid.12527.330000 0001 0662 3178Vanke School of Public Health, Tsinghua University, Beijing, 100084 China ,grid.12527.330000 0001 0662 3178School of Medicine, Tsinghua University, Beijing, 100084 China
| | - Feng Jiang
- grid.16821.3c0000 0004 0368 8293School of International and Public Affairs, Shanghai Jiao Tong University, Shanghai, China
| | - Jiming Zhu
- Vanke School of Public Health, Tsinghua University, Beijing, 100084, China.
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10
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Choubey AP, Reilly M, Bullock B, Ireland M, Brown M, Ortiz A, Pai K, Sureddi S, Khan SA, Mishra A, Koizumi N, Pearson T, Ortiz J. The Academic Footprint of Women in Transplantation: Leaky Pipeline Persists. Transplantation 2021; 105:2334-2336. [PMID: 34019360 DOI: 10.1097/tp.0000000000003748] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Affiliation(s)
- Ankur P Choubey
- Department of Surgery, University of Toledo Medical Center, OH
| | - Margaret Reilly
- Department of Surgery, University of Toledo Medical Center, OH
| | - Brenna Bullock
- Department of Surgery, University of Toledo Medical Center, OH
| | - Megan Ireland
- Department of Surgery, University of Toledo Medical Center, OH
| | - Meghan Brown
- Department of Surgery, University of Toledo Medical Center, OH
| | | | - Kavya Pai
- Department of Surgery, University of Toledo Medical Center, OH
| | - Sriya Sureddi
- Department of Surgery, University of Toledo Medical Center, OH
| | - Samar A Khan
- Department of Surgery, University of Toledo Medical Center, OH
| | - Anil Mishra
- Department of Surgery, University of Toledo Medical Center, OH
| | - Naoru Koizumi
- Schar School of Policy and Government, George Mason University, Fairfax, VA
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Abstract
STUDY DESIGN Cross-sectional survey study. OBJECTIVE To evaluate the prevalence of burnout, assess the personal and professional characteristics associated with burnout in spine surgeons and determine their quality of life. SUMMARY OF BACKGROUND DATA Burnout is a syndrome characterized by emotional exhaustion, depersonalization, and decreased sense of accomplishment that leads to decreased effectiveness at work. To date, there has been a lack of information on the prevalence of burnout among spine surgeons worldwide and the risk factors associated with this condition. METHODS An electronic survey with members of AO Spine was performed in May 2018. The survey evaluated demographic variables, practice characteristics, burnout, and quality of life. Maslach Burnout Inventory (MBI) and EuroQol 5-dimensions (EQ5D) were used to evaluate burnout and quality of life, respectively. RESULTS A total of 818 surgeons from 86 countries completed the survey. The prevalence of burnout was 30.6%. In the multiple linear model, emotional fatigue was independently associated with younger age (B = -0.17, CI95% = -0.26 to -0.07, P < 0.0001), and longer working hours per week (B = -2.71, CI95% = -4.34 to -1.07, P = 0.001); depersonalization was independently associated with younger age (B = -0.13, CI95% = -0.19 to -0.07, P < 0.0001), practicing outside Latin America (LA) (B = 0.71, CI95% = 0.41-1.01, P < 0.0001) and currently being a fellow (B = 0.54, CI95% = 0.06-1.02, P = 0.02); and higher scores of personal fulfilment was associated with practicing in LA (B = -1.27, CI95% = -1.69 to -0.85, P < 0.0001). CONCLUSION Burnout is a common condition among spine surgeons worldwide. There is a significant association between burnout scores and decreased general quality of life. These results highlight the need to develop interventional programs to better identify, prevent, and manage this condition among practicing spine surgeons.Level of Evidence: 4.
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12
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Davis MJ, Luu BC, Cole SH, Abu-Ghname A, Winocour S, Reece EM. Employment as a Plastic Surgeon: A Review of Trends and Demand Across the Field. Ann Plast Surg 2021; 87:377-383. [PMID: 34117135 DOI: 10.1097/sap.0000000000002780] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
ABSTRACT Intrinsic to the field of plastic surgery, constant changes in health care policy, consumer demands, and medical technology necessitate periodic evaluation of trends in employment over time. In this article, we review the existing literature to report the current state of plastic surgery employment in the United States with regards to compensation, practice patterns, subspecialty trends, contract negotiation, representation of women in the field of plastic surgery, burnout and job satisfaction, and retirement. Understanding how the plastic surgery job market is changing not only serves as a valuable tool for the individual plastic surgeon regarding the navigation of his or her own career but also offers insight into the future of the field as a whole.
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Affiliation(s)
| | - Bryan C Luu
- From the Division of Plastic Surgery, Michael E. DeBakey Department of Surgery, Baylor College of Medicine
| | - Samuel H Cole
- Section of Plastic and Reconstructive Surgery, School of Medicine, Louisiana State University Health Sciences Center, New Orleans, LA
| | | | - Sebastian Winocour
- From the Division of Plastic Surgery, Michael E. DeBakey Department of Surgery, Baylor College of Medicine
| | - Edward M Reece
- From the Division of Plastic Surgery, Michael E. DeBakey Department of Surgery, Baylor College of Medicine
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13
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Valbuena VSM, Obayemi JE, Purnell TS, Scantlebury VP, Olthoff KM, Martins PN, Higgins RS, Blackstock DM, Dick AAS, Watkins AC, Englesbe MJ, Simpson DC. Gender and racial disparities in the transplant surgery workforce. Curr Opin Organ Transplant 2021; 26:560-566. [PMID: 34524181 PMCID: PMC8524746 DOI: 10.1097/mot.0000000000000915] [Citation(s) in RCA: 20] [Impact Index Per Article: 6.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
PURPOSE OF REVIEW This review explores trends in the United States (US) transplant surgery workforce with a focus on historical demographics, post-fellowship job market, and quality of life reported by transplant surgeons. Ongoing efforts to improve women and racial/ethnic minority representation in transplant surgery are highlighted. Future directions to create a transplant workforce that reflects the diversity of the US population are discussed. RECENT FINDINGS Representation of women and racial and ethnic minorities among transplant surgeons is minimal. Although recent data shows an improvement in the number of Black transplant surgeons from 2% to 5.5% and an increase in women to 12%, the White to Non-White transplant workforce ratio has increased 35% from 2000 to 2013. Transplant surgeons report an average of 4.3 call nights per week and less than five leisure days a month. Transplant ranks 1st among surgical sub-specialties in the prevalence of three well-studied facets of burnout. Concerns about lifestyle may contribute to the decreasing demand for advanced training in abdominal transplantation by US graduates. SUMMARY Minimal improvements have been made in transplant surgery workforce diversity. Sustained and intentional recruitment and promotion efforts are needed to improve the representation of women and minority physicians and advanced practice providers in the field.
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Affiliation(s)
- Valeria S. M. Valbuena
- Department of Surgery, University of Michigan, Ann Arbor, MI, USA
- National Clinician Scholars Program, University of Michigan, Ann Arbor, MI, USA
| | - Joy E. Obayemi
- Department of Surgery, University of Michigan, Ann Arbor, MI, USA
| | - Tanjala S. Purnell
- Department of Surgery, Johns Hopkins School of Medicine, Baltimore, MD, USA
| | - Velma P. Scantlebury
- Texas Christian University and University of North Texas Health Science Center, Fort Worth, TX, USA
| | - Kim M. Olthoff
- Department of Surgery, Division of Transplant Surgery, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA, USA
| | - Paulo N. Martins
- Department of Surgery, Division of Organ Transplantation, UMass Memorial Medical Center, University of Massachusetts, Worcester, MA, USA
| | - Robert S. Higgins
- Department of Surgery, Johns Hopkins School of Medicine, Baltimore, MD, USA
| | | | - André A. S. Dick
- Department of Surgery, Division of Transplantation, University of Washington, Seattle, WA, USA
| | - Anthony C. Watkins
- Department of Surgery, New York University Grossman School of Medicine, New York, NY, USA
| | | | - Dinee C. Simpson
- Department of Surgery, Feinberg School of Medicine, Northwestern University, Chicago, IL, USA
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14
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Doolittle BR. Association of Burnout with Emotional Coping Strategies, Friendship, and Institutional Support Among Internal Medicine Physicians. J Clin Psychol Med Settings 2021; 28:361-367. [PMID: 32415546 PMCID: PMC7225246 DOI: 10.1007/s10880-020-09724-6] [Citation(s) in RCA: 17] [Impact Index Per Article: 5.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/23/2022]
Abstract
Physician burnout influences physician mental health, staff stress, safety events, and patient outcomes. The association of burnout with compassion satisfaction, secondary stress, emotional coping strategies and many psychosocial variables, such as institutional support, friendship, and spirituality, have not been well studied. A convenience sample of internal medicine physicians was emailed a survey using validated instruments to explore these associations. The response rate was 337/1021 (33%), with a burnout prevalence of 175/337 (52%). Grit, acceptance, active coping, positive reframing, and strategy planning were associated with lower burnout domains and greater compassion satisfaction. Certain emotional coping strategies such as denial, disengagement, self-blame, substance abuse, and venting were associated with greater burnout and lower compassion satisfaction. Greater institutional support was associated with lower burnout (r = − .35, p < .001), secondary stress (r = − .14, p < .05), and compassion satisfaction (r = .28, p < .0001). Friendship was associated with lower burnout (r = − .25, p < .0001) and greater compassion satisfaction (r = .28, p < .0001). This study suggests that amelioration of burnout requires both intrinsic strategies that emphasize physician coping skills as well as extrinsic strategies that address institutional support.
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Affiliation(s)
- Benjamin R Doolittle
- Departments of Internal Medicine and Pediatrics, Yale University School of Medicine, 333 Cedar Street - 1074LMP, PO BOX 8033, New Haven, CT, 06520, USA.
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15
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Chiodo Ortiz A, Choubey AP, Pai K, Khan S, Mishra A, Bullock B, Sureddi S, James R, Siddique AB, Koizumi N, Ortiz J. Kidney transplant surgical director training: Urologists represent a functional alternative to general surgeons. Clin Transplant 2021; 35:e14385. [PMID: 34132442 DOI: 10.1111/ctr.14385] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/11/2021] [Revised: 05/18/2021] [Accepted: 06/02/2021] [Indexed: 12/12/2022]
Abstract
INTRODUCTION Kidney transplant (KT) directors are general surgeons or urologists. All KT centers must meet established performance standards. However, it has not been established if general surgery and urology led programs have disparate outcomes. METHODS Transplant outcomes and donor-recipient characteristics by director training were investigated. Organ Procurement and Transplantation Network (OPTN) directory, program websites were analyzed for surgical director demographics. Scientific Registry of Transplant Recipients (SRTR) 1-year kidney survival and deceased donor (DD) wait-time rankings were evaluated. A retrospective analysis of 142 157 KT recipients from 2010 to 2019 was performed using the United Network for Organ Sharing (UNOS) database. RESULTS One hunderd and seventy three (90.6%) KT programs were led by general surgeons. There were no significant differences in gender, ethnicity, region, credentials, or fellowship completion. Recipients undergoing KT with urology led programs were older (P = .002) and had longer wait-times (P < .001). These centers used higher KDPI (.47 vs. .45, P < .001) and higher HLA mismatch (3.92 vs. 3.89, P = .02) kidneys. Urology led centers utilized living donors less frequently (32.1% vs. 35.8%, P < .001) and had longer CIT (15.44 vs. 12.21, P < .001). Both had similar SRTR ranking of 1-year survival and DD wait-time. CONCLUSION Most directors were general surgeon. Patient outcomes did not differ by transplant director training. Urologists represent a viable option for KT leadership and recruitment should be encouraged.
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Affiliation(s)
- A Chiodo Ortiz
- Department of Surgery, Albany Medical Center, Albany, New York, USA
| | - Ankur P Choubey
- Department of Surgery, Rutgers Robert Wood Johnson University Hospital, New Brunswick, New Jersey, USA
| | - K Pai
- Department of Surgery, University of Toledo Medical Center, Toledo, Ohio, USA
| | - S Khan
- Department of Surgery, University of Toledo Medical Center, Toledo, Ohio, USA
| | - A Mishra
- Department of Surgery, University of Toledo Medical Center, Toledo, Ohio, USA
| | - B Bullock
- Department of Surgery, University of Toledo Medical Center, Toledo, Ohio, USA
| | - S Sureddi
- Department of Surgery, University of Toledo Medical Center, Toledo, Ohio, USA
| | - R James
- Schar School of Policy and Government, George Mason University, Fairfax, Virginia, USA
| | - A B Siddique
- Schar School of Policy and Government, George Mason University, Fairfax, Virginia, USA
| | - N Koizumi
- Schar School of Policy and Government, George Mason University, Fairfax, Virginia, USA
| | - J Ortiz
- Department of Surgery, Albany Medical Center, Albany, New York, USA
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16
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Strategies to Improve Liver Allocation, Distribution, and Utilization in a Broader Sharing Climate. CURRENT TRANSPLANTATION REPORTS 2021. [DOI: 10.1007/s40472-021-00316-3] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/11/2022]
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17
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Kassam AF, Cortez AR, Winer LK, Conzen KD, El-Hinnawi A, Jones CM, Matsuoka L, Watkins AC, Collins KM, Bhati C, Selzner M, Sonnenday CJ, Englesbe MJ, Diwan TS, Dick AAS, Quillin RC. Extinguishing burnout: National analysis of predictors and effects of burnout in abdominal transplant surgery fellows. Am J Transplant 2021; 21:307-313. [PMID: 32463950 DOI: 10.1111/ajt.16075] [Citation(s) in RCA: 19] [Impact Index Per Article: 6.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/07/2020] [Revised: 05/13/2020] [Accepted: 05/15/2020] [Indexed: 01/25/2023]
Abstract
Burnout among surgeons has been attributed to increased workload and decreased autonomy. Although prior studies have examined burnout among transplant surgeons, no studies have evaluated burnout in abdominal transplant surgery fellows. The objective of our study was to identify predictors of burnout and understand its impact on personal and patient care during fellowship. A survey was sent to all abdominal transplant surgery fellows in an American Society of Transplant Surgeons-accredited fellowship. The response rate was 59.2% (n = 77) and 22.7% (n = 17) of fellows met criteria for burnout. Fellows with lower grit scores were more likely to exhibit burnout compared with fellows with higher scores (3.6 vs 4.0, P = .026). Those with burnout were more likely to work >100 hours per week (58.8% vs 27.6%, P = .023), have severe work-related stress (58.8% vs 22.4%, P = .010), consider quitting fellowship (94.1% vs 20.7%, P < .001), or make a medical error (35.3% vs 5.2%, P = .003). This national analysis of abdominal transplant fellows found that burnout rates are relatively low, but few fellows engage in self-care. Personal and program-related factors attribute to burnout and it has unacceptable effects on patient care. Transplant societies and fellowship programs should develop interventions to give fellows tools to prevent and combat burnout.
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Affiliation(s)
- Al-Faraaz Kassam
- Cincinnati Research on Education in Surgical Training (CREST), Cincinnati, Ohio, USA.,Department of Surgery, University of Cincinnati, Cincinnati, Ohio, USA
| | - Alexander R Cortez
- Cincinnati Research on Education in Surgical Training (CREST), Cincinnati, Ohio, USA.,Department of Surgery, University of Cincinnati, Cincinnati, Ohio, USA
| | - Leah K Winer
- Cincinnati Research on Education in Surgical Training (CREST), Cincinnati, Ohio, USA.,Department of Surgery, University of Cincinnati, Cincinnati, Ohio, USA
| | - Kendra D Conzen
- Department of Surgery, University of Colorado, Aurora, Colorado, USA
| | - Ashraf El-Hinnawi
- Department of Surgery, The Ohio State University, Columbus, Ohio, USA
| | | | - Lea Matsuoka
- Department of Surgery, Vanderbilt University Medical Center, Nashville, Tennessee, USA
| | - Anthony C Watkins
- Weill Cornell Medicine, New York Presbyterian Hospital, New York, New York, USA
| | - Kelly M Collins
- Department of Transplantation and Hepatobiliary Surgery, Henry Ford Hospital, Detroit, Michigan, USA
| | - Chandra Bhati
- Department of Surgery, Virginia Commonwealth University, Richmond, Virginia, USA
| | - Markus Selzner
- Department of Surgery, Toronto General Hospital, Toronto, Ontario, Canada
| | | | | | - Tayyab S Diwan
- Department of Surgery, University of Cincinnati, Cincinnati, Ohio, USA
| | - André A S Dick
- Department of Surgery, University of Washington, Seattle, Washington, USA.,Seattle Children's Hospital, Seattle, Washington, USA
| | - Ralph C Quillin
- Cincinnati Research on Education in Surgical Training (CREST), Cincinnati, Ohio, USA.,Department of Surgery, University of Cincinnati, Cincinnati, Ohio, USA
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18
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Scandling JD. The weekend effect and workforce in kidney transplantation. Transpl Int 2020; 33:1013-1015. [PMID: 32558977 DOI: 10.1111/tri.13676] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/08/2020] [Accepted: 06/10/2020] [Indexed: 11/29/2022]
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19
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Price ET, Coverley CR, Arrington AK, Nfonsam VN, Morris-Wiseman L, Riall TS. Are We Making an Impact? A Qualitative Program Assessment of the Resident Leadership, Well-being, and Resiliency Program for General Surgery Residents. JOURNAL OF SURGICAL EDUCATION 2020; 77:508-519. [PMID: 31859228 DOI: 10.1016/j.jsurg.2019.12.003] [Citation(s) in RCA: 19] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 06/21/2019] [Revised: 11/03/2019] [Accepted: 12/01/2019] [Indexed: 06/10/2023]
Abstract
OBJECTIVE After implementing a formal resident well-being and resiliency program in our surgery residency, we performed in-depth qualitative interviews to understand residents' perceptions of: (1) the impact and benefits, (2) the essential elements for success, and (3) the desired changes to the well-being program. DESIGN The well-being program is structured to address mental, physical, and social aspects of resident well-being through monthly experiential sessions. All General Surgery residents participated in the program; content is delivered during residents' protected educational time. For this study, we conducted individual semistructured interviews: residents were asked for their feedback to understand the value, benefits, and drawbacks of program. SETTING Accreditation Council for Graduate Medical Education-accredited General Surgery residency program PARTICIPANTS: We used purposeful selection to maximize diversity in recruiting residents who had participated in program for at least 1 year. Recruitment continued until themes were saturated. Eleven residents were interviewed including 2 from each residency year. RESULTS Residents reported benefits in 3 thematic spheres: (1) Culture/Community, (2) Communication/Emotional Intelligence, and (3) Work-Life Integration Skills. Key structural elements of success for a well-being program included a committed leader, a receptive department culture, occurrence during protected time, and interactive sessions that taught applicable life skills. In discussing opportunities for improvement, residents desired more faculty-level involvement. Some residents were skeptical of the benefit of time spent learning nontechnical skills; some wanted more emphasis placed on accountability to patients and work. CONCLUSIONS Our qualitative assessment of a novel resident well-being program demonstrates reported benefits that reflect the intent of the program. Residents most benefited from sessions that were interactive, introduced readily applicable skills for their day-to-day lives, and included reinforcement of principles through experiential learning. Engagement of the department leadership is essential to the success of the program, as is ongoing feedback and modification to ensure that program is tailored to the needs of residents.
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Affiliation(s)
- Elinora T Price
- Department of Surgery, University of Arizona, Tucson, Arizona
| | | | | | | | | | - Taylor S Riall
- Department of Surgery, University of Arizona, Tucson, Arizona.
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20
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Tangul SU, Hacimusalar Y, Karaaslan O. The Effects of Working Hours on Sleep Quality and Burnout in Turkish Pediatric Surgeons. Indian J Surg 2020. [DOI: 10.1007/s12262-019-01923-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022] Open
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21
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Factors That Affect Medical Students' Perception and Impression of a Plastic Surgery Program: The Role of Elective Rotations and Interviews. Ann Plast Surg 2020; 82:224-228. [PMID: 29916893 DOI: 10.1097/sap.0000000000001525] [Citation(s) in RCA: 28] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
OBJECTIVE Securing a residency training position in plastic surgery is highly competitive each year with a limited quota of positions and numerous qualified applicants. Although previous studies have highlighted the importance of residency programs and applicants seeking a "good fit," it remains poorly understood what influences a medical student's impression and desire to train at a certain program over others. The objective of this cross-sectional study was to identify which specific potentially modifiable factors during elective rotations and program interviews were most important to Canadian medical students when ranking plastic surgery programs. METHODS An electronic survey with 42 questions was administered to Canadian final year medical students who applied through the 2017 Canadian Residency Match Service to the plastic surgery training program at the University of Toronto. The survey consisted of 7-point Likert scale questions related to demographics, general factors affecting impression of a plastic surgery program, and specific factors related to the elective and interview experiences. Survey responses were collected anonymously for analysis. RESULTS Twenty-three of 46 applicants completed the survey (50% response rate). The most important general factors affecting a medical student's impression and desire to train at a residency program were mentors at a specific program (weighted average, 6.39) and geographic location of a program (weighted average, 5.65). During elective rotations, the most important factors identified were overall impression of resident and staff collegiality (weighted average, 6.57), overall impression of resident happiness (weighted average, 6.52), and having a formal rotation-end debrief evaluation with the supervising staff (weighted average, 6.04). At program interviews, perceiving an atmosphere of collegiality (weighted average, 6.45) and opportunities to interact with residents and faculty at an organized social event (weighted average, 5.95) were considered of greatest importance. CONCLUSIONS Current applicants to plastic surgery in Canada prioritize resident happiness, program collegiality, and meaningful faculty relationships, such as those with a mentor, when ranking residency programs. Although finding a mutually "good fit" between applicant and program will remain a major aim, these findings indicate the importance of certain tangible, potentially modifiable factors that affect how medical students ultimately perceive and rank plastic surgery programs.
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22
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Kancherla BS, Upender R, Collen JF, Rishi MA, Sullivan SS, Ahmed O, Berneking M, Flynn-Evans EE, Peters BR, Abbasi-Feinberg F, Aurora RN, Carden KA, Kirsch DB, Kristo DA, Malhotra RK, Martin JL, Olson EJ, Ramar K, Rosen CL, Rowley JA, Shelgikar AV, Gurubhagavatula I. Sleep, fatigue and burnout among physicians: an American Academy of Sleep Medicine position statement. J Clin Sleep Med 2020; 16:803-805. [PMID: 32108570 DOI: 10.5664/jcsm.8408] [Citation(s) in RCA: 28] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/20/2022]
Abstract
None Physician burnout is a serious and growing threat to the medical profession and may undermine efforts to maintain a sufficient physician workforce to care for the growing and aging patient population in the United States. Burnout involves a host of complex underlying associations and potential for risk. While prevalence is unknown, recent estimates of physician burnout are quite high, approaching 50% or more, with midcareer physicians at highest risk. Sleep deprivation due to shift-work schedules, high workload, long hours, sleep interruptions, and insufficient recovery sleep have been implicated in the genesis and perpetuation of burnout. Maladaptive attitudes regarding sleep and endurance also may increase the risk for sleep deprivation among attending physicians. While duty-hour restrictions have been instituted to protect sleep opportunity among trainees, virtually no such effort has been made for attending physicians who have completed their training or practicing physicians in nonacademic settings. It is the position of the American Academy of Sleep Medicine that a critical need exists to evaluate the roles of sleep disruption, sleep deprivation, and circadian misalignment in physician well-being and burnout. Such evaluation may pave the way for the development of effective countermeasures that promote healthy sleep, with the goal of reducing burnout and its negative impacts such as a shrinking physician workforce, poor physician health and functional outcomes, lower quality of care, and compromised patient safety.
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Affiliation(s)
- Binal S Kancherla
- Department of Pediatrics, Division of Pediatric Pulmonology, Texas Children's Hospital - Baylor College of Medicine, Houston, Texas
| | - Raghu Upender
- Department of Neurology, Division of Sleep Medicine, Vanderbilt Medical Center, Nashville, Tennessee
| | - Jacob F Collen
- Pulmonary, Critical Care and Sleep Medicine Service, Walter Reed National Military Medical Center, Bethesda, Maryland
| | - Muhammad Adeel Rishi
- Department of Pulmonology, Critical Care and Sleep Medicine, Mayo Clinic, Eau Claire, Wisconsin
| | | | - Omer Ahmed
- Department of Medicine, Division of Pulmonary, Critical Care and Sleep Medicine, New York University School of Medicine, New York, New York
| | | | - Erin E Flynn-Evans
- Fatigue Countermeasures Laboratory, Human Systems Integration Division, NASA Ames Research Center, Moffett Field, California
| | - Brandon R Peters
- Sleep Disorders Center, Virginia Mason Medical Center, Seattle, Washington
| | | | - R Nisha Aurora
- Department of Medicine, Rutgers Robert Wood Johnson Medical School, New Brunswick, New Jersey
| | - Kelly A Carden
- Saint Thomas Medical Partners - Sleep Specialists, Nashville, Tennessee
| | | | | | - Raman K Malhotra
- Sleep Medicine Center, Washington University School of Medicine, St. Louis, Missouri
| | - Jennifer L Martin
- Veteran Affairs Greater Los Angeles Healthcare System, North Hills, California.,David Geffen School of Medicine at the University of California, Los Angeles, California
| | - Eric J Olson
- Division of Pulmonary and Critical Care Medicine, Center for Sleep Medicine, Mayo Clinic, Rochester, Minnesota
| | - Kannan Ramar
- Division of Pulmonary and Critical Care Medicine, Center for Sleep Medicine, Mayo Clinic, Rochester, Minnesota
| | - Carol L Rosen
- Department of Pediatrics, Case Western Reserve University, University Hospitals - Cleveland Medical Center, Cleveland, Ohio
| | | | - Anita V Shelgikar
- University of Michigan Sleep Disorders Center, University of Michigan, Ann Arbor, Michigan
| | - Indira Gurubhagavatula
- Division of Sleep Medicine, Perelman School of Medicine, University of Pennsylvania, Philadelphia, Pennsylvania.,Corporal Michael Crescenz VA Medical Center, Philadelphia, Pennsylvania
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23
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Petrut B, Berindan-Neagoe I, Feflea DI, Hogea M, Pasca S, Bujoreanu CE, Bschleipfer T. Mental Fatigue Evaluation of Surgical Teams during a Regular Workday in a High-Volume Tertiary Healthcare Center. Urol Int 2020; 104:301-308. [PMID: 31955166 DOI: 10.1159/000504988] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/25/2019] [Accepted: 11/24/2019] [Indexed: 11/19/2022]
Abstract
INTRODUCTION Considering the complex set of manual and psychological tasks a surgeon has to perform during the day, it is very important to assess the surgeon's fatigability, reaction time, attention, and memory. OBJECTIVE Here, we wanted to determine the mental fatigue status of surgeons and how their abilities are affected through a regular workday. METHODS We included 3 senior urologists and 6 urology residents. In a set period of time, we assessed their fatigue through self-assessed fatigue, Samn-Perelli score, and Karolinska sleepiness scale score. Further, reaction time, attention, and memory correlated with the number of the operations in the day, and total number of operations in that day were assessed. RESULTS As the number of tasks increases, and as the surgeons advance to the end of the workday, they become more fatigued, reaction time ultimately increases, and attention and memory become slightly altered. CONCLUSIONS Complications resulting from the fatigue of surgeons could be serious. Their performance status and skills decrease as they perform more tasks or advance through the day.
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Affiliation(s)
- Bogdan Petrut
- Iuliu Hatieganu University of Medicine and Pharmacy, Cluj-Napoca, Romania
| | | | - Dragos I Feflea
- Department of Urology, Prof. Dr. Ion Chiricuta Institute of Oncology, Cluj-Napoca, Romania
| | | | - Sergiu Pasca
- Department of Functional Genomics, Prof. Dr. Ion Chiricuta Institute of Oncology, Cluj-Napoca, Romania
| | - Cristina E Bujoreanu
- Department of Urology, Prof. Dr. Ion Chiricuta Institute of Oncology, Cluj-Napoca, Romania,
| | - Thomas Bschleipfer
- Clinic for Urology, Andrology and Pediatric Urology, Clinics of Nordoberpfalz AG, Weiden, Germany
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24
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Kaldas FM, Rocca JP, Bhati CS, Duan N, Evenson AR, Tan HP, Redfield RR, di Sabato DM, Yoshida A, Abt PL, Geevarghese SK. The Abdominal Transplant Surgery Workforce: Current state and future trends. Clin Transplant 2019; 33:e13659. [DOI: 10.1111/ctr.13659] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/08/2019] [Revised: 06/21/2019] [Accepted: 07/01/2019] [Indexed: 11/28/2022]
Affiliation(s)
- Fady M. Kaldas
- Ronald Reagan UCLA Medical Center Los Angeles California
| | | | | | - Ning Duan
- American Society of Transplant Surgeons Arlington Virginia
| | - Amy R. Evenson
- Beth Israel Deaconess Medical Center Boston Massachusetts
| | - Henkie P. Tan
- University of Pittsburgh Medical Center Pittsburgh Pennsylvania
| | - Robert R. Redfield
- University of Wisconsin School of Medicine and Public Health Madison Wisconsin
| | | | | | - Peter L. Abt
- University of Pennsylvania Philadelphia Pennsylvania
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25
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Senturk JC, Melnitchouk N. Surgeon Burnout: Defining, Identifying, and Addressing the New Reality. Clin Colon Rectal Surg 2019; 32:407-414. [PMID: 31824232 DOI: 10.1055/s-0039-1692709] [Citation(s) in RCA: 22] [Impact Index Per Article: 4.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/17/2022]
Abstract
Surgeon wellness is a multidimensional commitment that encompasses occupational, mental, physical, emotional, and social domains. Loss of professional control, autonomy, and flexibility; inefficient processes; disjointed workplace relationships and goals; excessive administrative burdens; poor work-life balance; and frustrations with medical record and order entry systems have all been associated with burnout. Described as a syndrome of emotional exhaustion, depersonalization, and loss of a sense of personal accomplishment, burnout can have myriad untoward consequences. The strong link between surgeons' personal and professional identities can lead to a perfect storm of burnout, depression, compromised patient safety and quality of care, physician job loss and career dissatisfaction, substance abuse, damage to personal relationships, and suicide. The alarming scope of this problem cannot be confined to a single specialty or practice setting and is expected to increase without much needed changes to surgeon work practices and work environments. A heightened focus on wellness in the workplace with attention to improving workflow, scheduling, collaboration, and resource allocation is a welcome step taken by several institutions and championed by professional societies. Much more research is needed to reliably gauge the overall effectiveness of these approaches, further address the nuances of burnout as it applies specifically to surgeons, and ensure that members of the surgical workforce remain at their peak throughout the duration of their careers.
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Affiliation(s)
- James C Senturk
- Department of Surgery, Brigham and Women's Hospital, Harvard Medical School, Boston, Massachusetts
| | - Nelya Melnitchouk
- Department of Surgery, Brigham and Women's Hospital, Harvard Medical School, Boston, Massachusetts
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26
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Abstract
Burnout is characterized by emotional exhaustion, depersonalization, and a reduced sense of personal accomplishment. All physicians, and especially surgeons, are at risk for developing burnout. The best strategies for mitigating burnout mimic a modern approach to medicine: the development of preventive practices to protect, promote, and maintain health and well-being. Job satisfaction, job engagement, and compassion satisfaction help protect from burnout. Individual commitment to self-care in conjunction with support from within health care organizations create the optimal framework in which burnout can be mitigated.
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Affiliation(s)
- Timothy R Siegel
- Department of Surgery, Oregon Health and Sciences University, 3181 Southwest Sam Jackson Park Road, Mail Code: UHS-3, Portland, OR 97239, USA; Department of Medicine, Oregon Health and Sciences University, 3181 Southwest Sam Jackson Park Road, Mail Code: UHS-3, Portland, OR 97239, USA.
| | - Andrea K Nagengast
- Trauma, Critical Care and Acute Care Surgery, Department of Surgery, Oregon Health and Sciences University, 3181 Southwest Sam Jackson Park Road, Mail Code: L611, Portland, OR 97239, USA
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27
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Lindemann J, Dageforde LA, Brockmeier D, Vachharajani N, Scherer M, Chapman W, Doyle MBM. Organ procurement center allows for daytime liver transplantation with less resource utilization: May address burnout, pipeline, and safety for field of transplantation. Am J Transplant 2019; 19:1296-1304. [PMID: 30247814 DOI: 10.1111/ajt.15129] [Citation(s) in RCA: 18] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/10/2018] [Revised: 08/28/2018] [Accepted: 09/14/2018] [Indexed: 01/25/2023]
Abstract
Abdominal organ transplantation faces several challenges: burnout, limited pipeline of future surgeons, changes in liver allocation potentially impacting organ procurement travel, and travel safety. The organ procurement center (OPC) model may be one way to mitigate these issues. Liver transplants from 2009 to 2016 were reviewed. There were 755 liver transplants performed with 525 OPC and 230 in-hospital procurements. The majority of transplants (87.4%) were started during daytime hours (5 am-7 pm). Transplants with any portion occurring after-hours were more likely to have procurements in-hospital (P < .001). Daytime cases (n = 400) had more OPC procured livers and hepatitis C recipients and were less likely to have a donation after circulatory death donor (all P < .05). In adjusted analyses, daytime cases were independently associated with extubation in the operating room and less postoperative transfusion. There were no significant differences in short- or long-term postoperative outcomes. For exported livers, 54.3% were procured by a local team, saving 137 flights (151 559 miles). The OPC resulted in optimally timed liver transplants and decreased resource utilization with no negative impact on patient outcomes. It allows for ease in exporting organs procured by local surgeons, and potentially addresses provider burnout, the transplant surgery pipeline, and surgeon travel.
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Affiliation(s)
- Jessica Lindemann
- Division of Abdominal Organ Transplantation, Department of Surgery, Washington University School of Medicine, Saint Louis, Missouri
| | - Leigh Anne Dageforde
- Division of Transplantation, Department of Surgery, Mass General Hospital, Boston, Massachusetts
| | | | - Neeta Vachharajani
- Division of Abdominal Organ Transplantation, Department of Surgery, Washington University School of Medicine, Saint Louis, Missouri
| | - Meranda Scherer
- Division of Abdominal Organ Transplantation, Department of Surgery, Washington University School of Medicine, Saint Louis, Missouri
| | - William Chapman
- Division of Abdominal Organ Transplantation, Department of Surgery, Washington University School of Medicine, Saint Louis, Missouri
| | - Maria B Majella Doyle
- Division of Abdominal Organ Transplantation, Department of Surgery, Washington University School of Medicine, Saint Louis, Missouri
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Serenari M, Cucchetti A, Russo PM, Fallani G, Mattarozzi K, Pinna AD, Colonnello V, Poggioli G, Cescon M. Burnout and psychological distress between surgical and non-surgical residents. Updates Surg 2019; 71:323-330. [PMID: 30941702 DOI: 10.1007/s13304-019-00653-0] [Citation(s) in RCA: 17] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/27/2018] [Accepted: 03/27/2019] [Indexed: 11/30/2022]
Abstract
Surgical training is considered to be very stressful among residents and medical students choose less often surgery for their career. Our aim was to assess the prevalence of burnout and psychological distress in residents attending surgical specialties (SS) compared to non-surgical specialties (NSS). Residents from the University of Bologna were asked to participate in an anonymous online survey. The residents completed a set of questions regarding their training schedule and three standardized questionnaires: (1) the Maslach Burnout Inventory, assessing the three dimensions of burnout: emotional exhaustion (EE), depersonalization (DP), and personal accomplishment (PA); (2) the Zung Self-Rating Depression Scale; (3) the Psychosomatic Problems Scale. One-hundred and ninety residents completed the survey. Overall, the prevalence of burnout was 73% in the SS group and 56.3% in the NSS group (P = 0.026). More specifically, SS reported higher levels of EE and DP compared to NSS. No significant differences between SS and NSS emerged for PA, depression, or somatic problems. The present findings indicate that burnout is more prevalent in surgical residents than in residents attending non-surgical specialties. ClinicalTrials.gov identifier: NCT03668080.
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Affiliation(s)
- Matteo Serenari
- Department of Medical and Surgical Sciences-DIMEC, S.Orsola-Malpighi Hospital, Alma Mater Studiorum-University of Bologna, Bologna, Italy.
| | - Alessandro Cucchetti
- Department of Medical and Surgical Sciences-DIMEC, S.Orsola-Malpighi Hospital, Alma Mater Studiorum-University of Bologna, Bologna, Italy
| | - Paolo Maria Russo
- Department of Experimental, Diagnostic and Specialty Medicine-DIMES, Alma Mater Studiorum-University of Bologna, Bologna, Italy
| | - Guido Fallani
- Department of Medical and Surgical Sciences-DIMEC, S.Orsola-Malpighi Hospital, Alma Mater Studiorum-University of Bologna, Bologna, Italy
| | - Katia Mattarozzi
- Department of Experimental, Diagnostic and Specialty Medicine-DIMES, Alma Mater Studiorum-University of Bologna, Bologna, Italy
| | - Antonio Daniele Pinna
- Department of Medical and Surgical Sciences-DIMEC, S.Orsola-Malpighi Hospital, Alma Mater Studiorum-University of Bologna, Bologna, Italy
| | - Valentina Colonnello
- Department of Experimental, Diagnostic and Specialty Medicine-DIMES, Alma Mater Studiorum-University of Bologna, Bologna, Italy
| | - Gilberto Poggioli
- Department of Medical and Surgical Sciences-DIMEC, S.Orsola-Malpighi Hospital, Alma Mater Studiorum-University of Bologna, Bologna, Italy
| | - Matteo Cescon
- Department of Medical and Surgical Sciences-DIMEC, S.Orsola-Malpighi Hospital, Alma Mater Studiorum-University of Bologna, Bologna, Italy
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Feinstein MA, Marcus SG, Amara DP, Durcanova B, Roll GR, Orandi BJ. The effect of an organ procurement experience on preclinical medical student perceptions of transplant surgery. Clin Transplant 2019; 33:e13505. [PMID: 30791137 DOI: 10.1111/ctr.13505] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/10/2018] [Revised: 01/14/2019] [Accepted: 02/12/2019] [Indexed: 11/28/2022]
Abstract
Transplant surgery is a predominantly male specialty with high burnout rates. There are currently limited data regarding how programs can attract a diverse applicant pool to the field of transplant surgery. This study evaluated the effect of an Organ Procurement Experience elective on preclinical medical students' perceptions of transplant surgery in a prospective, longitudinal study. Preclinical medical students were anonymously surveyed before and after attending a deceased donor organ procurement. Questions focused on the following themes: Personal Beliefs, Personal/Professional Life, Diversity, and Gender Equality. Responses were rated on a five-point Likert scale. Ninety-nine and 45 students completed pre/post-procurement survey, respectively. Post-procurement responses demonstrated increased education about the field (2.1/5 vs 3.89/5, P < 0.001) and perceptions of the personalities and collegiality between surgeons (3.06/5 vs 3.73/5, P = 0.005). Post-procurement, women were less likely to feel that female transplant surgeons are treated differently (3.98/5 vs. 3.45/5, P < 0.017). Post-procurement, 19% agreed that transplant surgeons have a high quality of life. One percent of respondents felt the current gender distribution in transplant surgery is satisfactory. The Organ Procurement Experience significantly improved preclinical students' perceptions of the field. However, there remains a strong concern about quality of life and gender diversity within the field.
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Affiliation(s)
- Max A Feinstein
- University of California, San Francisco School of Medicine, San Francisco, California
| | - Sivan G Marcus
- University of California, San Francisco School of Medicine, San Francisco, California
| | - Dominic P Amara
- University of California, San Francisco School of Medicine, San Francisco, California
| | - Beata Durcanova
- University of California, San Francisco School of Medicine, San Francisco, California
| | - Garrett R Roll
- Division of Transplant Surgery, University of California, San Francisco, San Francisco, California
| | - Babak J Orandi
- Division of Transplant Surgery, University of Alabama at Birmingham, Birmingham, Alabama
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Soucacos PN, Mavrogenis AF. Reconstructive microsurgery. EUROPEAN JOURNAL OF ORTHOPAEDIC SURGERY AND TRAUMATOLOGY 2019; 29:245-246. [PMID: 30627924 DOI: 10.1007/s00590-019-02379-6] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Received: 01/02/2019] [Accepted: 01/04/2019] [Indexed: 11/24/2022]
Affiliation(s)
- Panayotis N Soucacos
- First Department of Orthopaedics, National and Kapodistrian University of Athens, School of Medicine, 41 Ventouri Street, 15562, Holargos, Athens, Greece
| | - Andreas F Mavrogenis
- First Department of Orthopaedics, National and Kapodistrian University of Athens, School of Medicine, 41 Ventouri Street, 15562, Holargos, Athens, Greece.
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Mallon C, Gooberman-Hill R, Blom A, Whitehouse M, Moore A. Surgeons are deeply affected when patients are diagnosed with prosthetic joint infection. PLoS One 2018; 13:e0207260. [PMID: 30485337 PMCID: PMC6261566 DOI: 10.1371/journal.pone.0207260] [Citation(s) in RCA: 19] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/13/2017] [Accepted: 10/29/2018] [Indexed: 11/18/2022] Open
Abstract
Knee replacement is a common preference sensitive quality-of-life procedure that can reduce pain and improve function for people with advanced knee arthritis. While most patients improve, knee replacement surgery has the potential for serious complications. Prosthetic knee infection is an uncommon but serious complication. This study explored the impact of cases of prosthetic knee infection on surgeons' personal and professional wellbeing. Qualitative telephone interviews were conducted with consultant orthopaedic surgeons who treated patients for prosthetic knee infection in one of six high-volume NHS orthopaedic departments. Data was audio-recorded, transcribed and analysed thematically. Eleven surgeons took part. Analysis identified three overarching themes: (i) At some point infection is inevitable but surgeons still feel accountable; (ii) A profound emotional impact and (iii) Supporting each other. The occurrence of prosthetic joint infection has a significant emotional impact on surgeons who report a collective sense of devastation and personal ownership, even though prosthetic joint infection cannot be fully controlled for. Surgeons stressed the importance of openly discussing the management of prosthetic joint infection with a supportive multidisciplinary team and this has implications for the ways in which orthopaedic surgeons may be best supported to manage this complication. This article also acknowledges that surgeons are not alone in experiencing personal impact when patients have infection.
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Affiliation(s)
- Charlotte Mallon
- Musculoskeletal Research Unit, Department of Translational Health Sciences, Bristol Medical School, University of Bristol, Bristol, United Kingdom
| | - Rachael Gooberman-Hill
- Musculoskeletal Research Unit, Department of Translational Health Sciences, Bristol Medical School, University of Bristol, Bristol, United Kingdom
- National Institute for Health Research Bristol Biomedical Research Centre, Bristol Medical School, University of Bristol, Bristol, United Kingdom
| | - Ashley Blom
- Musculoskeletal Research Unit, Department of Translational Health Sciences, Bristol Medical School, University of Bristol, Bristol, United Kingdom
- National Institute for Health Research Bristol Biomedical Research Centre, Bristol Medical School, University of Bristol, Bristol, United Kingdom
| | - Michael Whitehouse
- Musculoskeletal Research Unit, Department of Translational Health Sciences, Bristol Medical School, University of Bristol, Bristol, United Kingdom
- National Institute for Health Research Bristol Biomedical Research Centre, Bristol Medical School, University of Bristol, Bristol, United Kingdom
| | - Andrew Moore
- Musculoskeletal Research Unit, Department of Translational Health Sciences, Bristol Medical School, University of Bristol, Bristol, United Kingdom
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Rotenstein LS, Torre M, Ramos MA, Rosales RC, Guille C, Sen S, Mata DA. Prevalence of Burnout Among Physicians: A Systematic Review. JAMA 2018; 320:1131-1150. [PMID: 30326495 PMCID: PMC6233645 DOI: 10.1001/jama.2018.12777] [Citation(s) in RCA: 906] [Impact Index Per Article: 151.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/09/2018] [Accepted: 08/09/2018] [Indexed: 12/13/2022]
Abstract
Importance Burnout is a self-reported job-related syndrome increasingly recognized as a critical factor affecting physicians and their patients. An accurate estimate of burnout prevalence among physicians would have important health policy implications, but the overall prevalence is unknown. Objective To characterize the methods used to assess burnout and provide an estimate of the prevalence of physician burnout. Data Sources and Study Selection Systematic search of EMBASE, ERIC, MEDLINE/PubMed, psycARTICLES, and psycINFO for studies on the prevalence of burnout in practicing physicians (ie, excluding physicians in training) published before June 1, 2018. Data Extraction and Synthesis Burnout prevalence and study characteristics were extracted independently by 3 investigators. Although meta-analytic pooling was planned, variation in study designs and burnout ascertainment methods, as well as statistical heterogeneity, made quantitative pooling inappropriate. Therefore, studies were summarized descriptively and assessed qualitatively. Main Outcomes and Measures Point or period prevalence of burnout assessed by questionnaire. Results Burnout prevalence data were extracted from 182 studies involving 109 628 individuals in 45 countries published between 1991 and 2018. In all, 85.7% (156/182) of studies used a version of the Maslach Burnout Inventory (MBI) to assess burnout. Studies variably reported prevalence estimates of overall burnout or burnout subcomponents: 67.0% (122/182) on overall burnout, 72.0% (131/182) on emotional exhaustion, 68.1% (124/182) on depersonalization, and 63.2% (115/182) on low personal accomplishment. Studies used at least 142 unique definitions for meeting overall burnout or burnout subscale criteria, indicating substantial disagreement in the literature on what constituted burnout. Studies variably defined burnout based on predefined cutoff scores or sample quantiles and used markedly different cutoff definitions. Among studies using instruments based on the MBI, there were at least 47 distinct definitions of overall burnout prevalence and 29, 26, and 26 definitions of emotional exhaustion, depersonalization, and low personal accomplishment prevalence, respectively. Overall burnout prevalence ranged from 0% to 80.5%. Emotional exhaustion, depersonalization, and low personal accomplishment prevalence ranged from 0% to 86.2%, 0% to 89.9%, and 0% to 87.1%, respectively. Because of inconsistencies in definitions of and assessment methods for burnout across studies, associations between burnout and sex, age, geography, time, specialty, and depressive symptoms could not be reliably determined. Conclusions and Relevance In this systematic review, there was substantial variability in prevalence estimates of burnout among practicing physicians and marked variation in burnout definitions, assessment methods, and study quality. These findings preclude definitive conclusions about the prevalence of burnout and highlight the importance of developing a consensus definition of burnout and of standardizing measurement tools to assess the effects of chronic occupational stress on physicians.
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Affiliation(s)
- Lisa S. Rotenstein
- Harvard Medical School, Boston, Massachusetts
- Department of Medicine, Brigham and Women’s Hospital, Boston, Massachusetts
- Brigham Education Institute, Boston, Massachusetts
| | - Matthew Torre
- Harvard Medical School, Boston, Massachusetts
- Department of Pathology, Brigham and Women’s Hospital, Boston, Massachusetts
| | - Marco A. Ramos
- Department of Psychiatry, Yale School of Medicine, New Haven, Connecticut
| | - Rachael C. Rosales
- Harvard Medical School, Boston, Massachusetts
- Department of Psychiatry, Brigham and Women’s Hospital, Boston, Massachusetts
| | - Constance Guille
- Department of Psychiatry and Behavioral Sciences, Medical University of South Carolina, Charleston
| | - Srijan Sen
- Molecular and Behavioral Neuroscience Institute and Department of Psychiatry, University of Michigan, Ann Arbor
| | - Douglas A. Mata
- Harvard Medical School, Boston, Massachusetts
- Brigham Education Institute, Boston, Massachusetts
- Program in Molecular Pathological Epidemiology, Department of Pathology, Brigham and Women’s Hospital, Boston, Massachusetts
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Mao P, Cai P, Luo A, Huang P, Xie W. Factors in Organ Donation Coordinators: A Cross-Sectional Study in China. Ann Transplant 2018; 23:647-653. [PMID: 30213924 PMCID: PMC6248314 DOI: 10.12659/aot.910409] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/09/2022] Open
Abstract
Background Organ donation coordinators play an important role in the organ transplantation process. Job burnout can seriously affect their turnover rates and the organ donation rate. The present study investigated the level of job burnout and its related factors among organ donation coordinators in China. Material/Methods From March to May 2017, we administered questionnaire surveys to 320 organ donation coordinators from 32 cities. The questionnaire included the following: the Chinese version of MBI-GS was used to evaluate the burnout levels of organ donation coordinators, the Chinese version of GSES was used to assess related personal factors, and the Job Demands Scale and the SSRS were used to evaluate related environmental factors. Results We received a total of 283 questionnaires with a response rate of 88.4%. Out of 283 organ donation coordinators, 169 coordinators (59.7%) showed burnout symptoms. Among them, 161 (56.9%) had mild burnout and 8 (2.8%) had severe burnout. Analysis by multiple linear regression reveals that gender, marital status, educational level, work unit, type of coordinator, job demands, self-efficacy, social support, and job satisfaction are the main factors affecting job burnout in organ donation coordinators. Conclusions The prevalence of job burnout among Chinese organ donation coordinators is relatively high, with mild burnout as the main symptom and reduced personal accomplishment as the main clinical feature. We hope this study will provide a reference for the recruitment and reduction of coordinator burnout.
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Affiliation(s)
- Ping Mao
- Key Laboratory of Medical Information Research (Central South University), Third Xiangya Hospital of Central South University, College of Hunan Province, Changsha, Hunan, China (mainland)
| | - Pingping Cai
- Xiangya Nursing School of Central South University, Changsha, Hunan, China (mainland)
| | - Aijing Luo
- Key Laboratory of Medical Information Research (Central South University), Third Xiangya Hospital of Central South University, College of Hunan Province, Changsha, Hunan, China (mainland)
| | - Panhao Huang
- Department of Pharmacy, Third Xiangya Hospital of Central South University, Changsha, Hunan, China (mainland)
| | - Wenzhao Xie
- Key Laboratory of Medical Information Research (Central South University), Third Xiangya Hospital of Central South University, College of Hunan Province, Changsha, Hunan, China (mainland)
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Murali K, Banerjee S. Burnout in oncologists is a serious issue: What can we do about it? Cancer Treat Rev 2018; 68:55-61. [DOI: 10.1016/j.ctrv.2018.05.009] [Citation(s) in RCA: 29] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/14/2018] [Revised: 05/14/2018] [Accepted: 05/15/2018] [Indexed: 11/24/2022]
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Abstract
Physician burnout, a work-related syndrome involving emotional exhaustion, depersonalization and a sense of reduced personal accomplishment, is prevalent internationally. Rates of burnout symptoms that have been associated with adverse effects on patients, the healthcare workforce, costs and physician health exceed 50% in studies of both physicians-in-training and practicing physicians. This problem represents a public health crisis with negative impacts on individual physicians, patients and healthcare organizations and systems. Drivers of this epidemic are largely rooted within healthcare organizations and systems and include excessive workloads, inefficient work processes, clerical burdens, work-home conflicts, lack of input or control for physicians with respect to issues affecting their work lives, organizational support structures and leadership culture. Individual physician-level factors also play a role, with higher rates of burnout commonly reported in female and younger physicians. Effective solutions align with these drivers. For example, organizational efforts such as locally developed practice modifications and increased support for clinical work have demonstrated benefits in reducing burnout. Individually focused solutions such as mindfulness-based stress reduction and small-group programmes to promote community, connectedness and meaning have also been shown to be effective. Regardless of the specific approach taken, the problem of physician burnout is best addressed when viewed as a shared responsibility of both healthcare systems and individual physicians. Although our understanding of physician burnout has advanced considerably in recent years, many gaps in our knowledge remain. Longitudinal studies of burnout's effects and the impact of interventions on both burnout and its effects are needed, as are studies of effective solutions implemented in combination. For medicine to fulfil its mission for patients and for public health, all stakeholders in healthcare delivery must work together to develop and implement effective remedies for physician burnout.
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Affiliation(s)
- C P West
- Department of Medicine, Mayo Clinic, Rochester, MN, USA.,Department of Health Sciences Research, Mayo Clinic, Rochester, MN, USA
| | - L N Dyrbye
- Department of Medicine, Mayo Clinic, Rochester, MN, USA
| | - T D Shanafelt
- Department of Medicine, Stanford University Medical Center, Stanford, CA, USA
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Murali K, Makker V, Lynch J, Banerjee S. From Burnout to Resilience: An Update for Oncologists. Am Soc Clin Oncol Educ Book 2018; 38:862-872. [PMID: 30231394 DOI: 10.1200/edbk_201023] [Citation(s) in RCA: 34] [Impact Index Per Article: 5.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/08/2023]
Abstract
Physician burnout remains a highly complex and topical issue. The negative impact of burnout on physicians, patients, and institutions has become increasingly apparent. Globally, a multitude of professional bodies and organizational leaders are giving this important subject much-deserved attention. In this review, we provide a summary of the latest evidence, with a focus on solutions and future strategies, while incorporating our own perspectives as practicing oncologists.
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Affiliation(s)
- Krithika Murali
- From The Royal Marsden NHS Foundation Trust, London, United Kingdom; Memorial Sloan Kettering Cancer Center and Weill Cornell Medical College, New York, NY; College of Medicine, University of Florida, Gainesville, FL; Institute of Cancer Research, London, United Kingdom
| | - Vicky Makker
- From The Royal Marsden NHS Foundation Trust, London, United Kingdom; Memorial Sloan Kettering Cancer Center and Weill Cornell Medical College, New York, NY; College of Medicine, University of Florida, Gainesville, FL; Institute of Cancer Research, London, United Kingdom
| | - James Lynch
- From The Royal Marsden NHS Foundation Trust, London, United Kingdom; Memorial Sloan Kettering Cancer Center and Weill Cornell Medical College, New York, NY; College of Medicine, University of Florida, Gainesville, FL; Institute of Cancer Research, London, United Kingdom
| | - Susana Banerjee
- From The Royal Marsden NHS Foundation Trust, London, United Kingdom; Memorial Sloan Kettering Cancer Center and Weill Cornell Medical College, New York, NY; College of Medicine, University of Florida, Gainesville, FL; Institute of Cancer Research, London, United Kingdom
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Abouljoud M, Ryan M, Eshelman A, Bryce K, Jesse MT. Leadership Perspectives on Integrating Psychologists into Specialty Care Clinics: An Evolving Paradigm. J Clin Psychol Med Settings 2018; 25:267-277. [PMID: 29468571 DOI: 10.1007/s10880-017-9532-9] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/20/2022]
Abstract
Integration of health psychologists into specialty care is a shift in the tertiary care construct that addresses all aspects of a patient's presentation, including psychiatric/social history, psychological well-being, and behavioral contributions to the disease process, assuring both optimal health outcomes and cost-effectiveness in a financially challenging healthcare environment. In this paper, we discuss leadership perspectives (physician and psychologists) on the factors involved in integrating a health psychologist into a busy tertiary care environment. Ultimately, we hope that this information provides a primer on how to frame a proposal for an integrated health psychologist emphasizing the elements important to senior medical leadership and administration. First, we briefly discuss the current payer framework, providing support for integration emphasizing costs and other metrics. Second, we introduce organizational structure models and strategies for integration. Lastly, we will discuss the unique skillset psychologists possess, and additional skills necessary, to be effective in the changing landscape of healthcare. We think this information is important both for leaders attempting to integrate a health psychologist into specialty care and for the early career health psychologist embarking on his/her first senior staff position.
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Affiliation(s)
- Marwan Abouljoud
- Transplant Institute, Henry Ford Health System, Detroit, MI, 48202, USA
- Division of Transplant and Hepatobiliary Surgery, Department of Surgery, Henry Ford Health System, Detroit, MI, 48202, USA
| | - Michael Ryan
- Henry Ford Cancer Institute, Henry Ford Health System, Detroit, MI, 48202, USA
- Psychosomatic Medicine, Behavioral Health, Henry Ford Health System, Detroit, MI, 48202, USA
| | - Anne Eshelman
- Transplant Institute, Henry Ford Health System, Detroit, MI, 48202, USA
- Psychosomatic Medicine, Behavioral Health, Henry Ford Health System, Detroit, MI, 48202, USA
| | - Kelly Bryce
- Transplant Institute, Henry Ford Health System, Detroit, MI, 48202, USA
- Psychosomatic Medicine, Behavioral Health, Henry Ford Health System, Detroit, MI, 48202, USA
| | - Michelle T Jesse
- Transplant Institute, Henry Ford Health System, Detroit, MI, 48202, USA.
- Psychosomatic Medicine, Behavioral Health, Henry Ford Health System, Detroit, MI, 48202, USA.
- Center for Health Policy & Health Services Research, Henry Ford Health System, Detroit, MI, 48202, USA.
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Maintaining the Fire but Avoiding Burnout: Implementation and Evaluation of a Resident Well-Being Program. J Am Coll Surg 2017; 226:369-379. [PMID: 29289752 DOI: 10.1016/j.jamcollsurg.2017.12.017] [Citation(s) in RCA: 57] [Impact Index Per Article: 8.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/08/2017] [Accepted: 12/11/2017] [Indexed: 11/22/2022]
Abstract
BACKGROUND There have been few programs designed to improve surgical resident well-being, and such efforts often lack formal evaluation. STUDY DESIGN General surgery residents participated in the Energy Leadership Well-Being and Resiliency Program. They were assessed at baseline and 1 year after implementation using the Energy Leadership Index (measures emotional intelligence), Maslach Burnout Inventory General Survey, Perceived Stress Scale, the Beck Depression Inventory, and the annual required ACGME resident survey. Scores before and after implementation were compared using paired t-tests for continuous variables and chi-square tests for categorical variables. RESULTS Forty-nine general surgery residents participate in the program. One year after implementation, resident score on the Energy Leadership Index improved (from 3.16 ± 0.24 to 3.24 ± 0.32; p = 0.03). Resident perceived stress decreased from baseline (Perceived Stress Scale score, from 17.0 ± 7.2 to 15.7 ± 6.2; p = 0.05). Scores on the emotional exhaustion scale of the Maslach Burnout Inventory decreased (from 16.8 ± 8.4 to 14.4 ± 8.5; p = 0.04). Resident-reported satisfaction improved in many areas; satisfaction with leadership skills, work relationships, communication skills, productivity, time management, personal freedom, and work-life balance, increased during the 1-year intervention (p = NS). On the annual ACGME resident survey, residents' evaluation of the program as positive or very positive increased from 80% to 96%. CONCLUSIONS This study demonstrates that formal implementation of a program to improve resident well-being positively impacted residents' perceived stress, emotional exhaustion, emotional intelligence, life satisfaction, and their perception of the residency program. Formal evaluation and reporting of such efforts allow for reproducibility and scalability, with the potential for widespread impact on resident well-being.
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Wu D, Gross B, Rittenhouse K, Harnish C, Mooney C, Rogers FB. A Preliminary Analysis of Compassion Fatigue in a Surgeon Population: Are Female Surgeons at Heightened Risk? Am Surg 2017; 83:1302-1307. [PMID: 29183536 DOI: 10.1177/000313481708301136] [Citation(s) in RCA: 15] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Compassion fatigue (CF), a state of physical/emotional distress caused by repeatedly caring for those experiencing traumatic episodes, is a prevalent issue for today's healthcare provider. We sought to characterize levels of CF within a surgeon population, particularly comparing trauma surgery with other surgical specialties. A survey containing the Professional Quality of Life Scale (ProQOL), a validated tool assessing compassion satisfaction (CS), CF, and burnout (BO) was distributed via electronic newsletter to members of the American College of Surgeons. Demographic data and Professional Quality of Life Scale scores for CS, BO, and CF were collected and compared within specialty and gender subgroups. A total of 178 surgeons completed surveys. Respondents were predominantly male, general surgeons, >55 years old. Trauma surgeons composed the second largest subgroup. Levels of CS were significantly lower in the trauma surgeon subgroup compared to other surgical specialties (trauma: 37.1 ± 5.28, other: 39.5 ± 6.30; P = 0.044). Female surgeons from all specialties exhibited significantly higher levels of BO (female: 26.7 ± 6.10, male: 24.6 ± 6.79; P = 0.035) and CF (female: 24.2 ± 6.29, male: 21.9 ± 6.11; P = 0.021) compared with male surgeons. Subanalyses comparing female trauma surgeons to female surgeons in other specialties found female trauma surgeons exhibited significantly lower levels of CS (trauma: 34.8 ± 4.63, other: 38.8 ± 5.99; P = 0.038) and higher levels of BO (trauma: 29.1 ± 3.14, other: 25.3 ± 6.41; P = 0.049). Trauma surgeons, particularly female trauma surgeons, may be at a heightened risk for developing a poorer overall professional quality of life compared with surgeons of other specialties. In addition, female surgeons may be at greater risk for developing CF compared with male counterparts.
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Jones GM, Roe NA, Louden L, Tubbs CR. Factors Associated With Burnout Among US Hospital Clinical Pharmacy Practitioners: Results of a Nationwide Pilot Survey. Hosp Pharm 2017; 52:742-751. [PMID: 29276254 DOI: 10.1177/0018578717732339] [Citation(s) in RCA: 103] [Impact Index Per Article: 14.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Background: In health care, burnout has been defined as a psychological process whereby human service professionals attempting to positively impact the lives of others become overwhelmed and frustrated by unforeseen job stressors. Burnout among various physician groups who primarily practice in the hospital setting has been extensively studied; however, no evidence exists regarding burnout among hospital clinical pharmacists. Objective: The aim of this study was to characterize the level of and identify factors independently associated with burnout among clinical pharmacists practicing in an inpatient hospital setting within the United States. Methods: We conducted a prospective, cross-sectional pilot study utilizing an online, Qualtrics survey. Univariate analysis related to burnout was conducted, with multivariable logistic regression analysis used to identify factors independently associated with the burnout. Results: A total of 974 responses were analyzed (11.4% response rate). The majority were females who had practiced pharmacy for a median of 8 years. The burnout rate was high (61.2%) and largely driven by high emotional exhaustion. On multivariable analysis, we identified several subjective factors as being predictors of burnout, including inadequate administrative and teaching time, uncertainty of health care reform, too many nonclinical duties, difficult pharmacist colleagues, and feeling that contributions are underappreciated. Conclusions: The burnout rate of hospital clinical pharmacy providers was very high in this pilot survey. However, the overall response rate was low at 11.4%. The negative effects of burnout require further study and intervention to determine the influence of burnout on the lives of clinical pharmacists and on other health care-related outcomes.
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Affiliation(s)
- G Morgan Jones
- Methodist University Hospital, Memphis, TN, USA.,University of Tennessee Health Science Center, Memphis, TN, USA.,Baptist Health Medical Center-Little Rock, AR, USA
| | - Neil A Roe
- Baptist Health Medical Center-Little Rock, AR, USA
| | | | - Crystal R Tubbs
- The Ohio State University Wexner Medical Center, Columbus, OH, USA
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Abstract
BACKGROUND Physician burnout in the United States has reached epidemic proportions and is rising rapidly, although burnout in other occupations is stable. Its negative impact is far reaching and includes harm to the burned-out physician, as well as patients, coworkers, family members, close friends, and healthcare organizations. OBJECTIVE The purpose of this review is to provide an accurate, current summary of what is known about physician burnout and to develop a framework to reverse its current negative impact, decrease its prevalence, and implement effective organizational and personal interventions. DATA SOURCES I completed a comprehensive MEDLINE search of the medical literature from January 1, 2000, through December 28, 2016, related to medical student and physician burnout, stress, depression, suicide ideation, suicide, resiliency, wellness, and well-being. In addition, I selectively reviewed secondary articles, books addressing the relevant issues, and oral presentations at national professional meetings since 2013. STUDY SELECTION Healthcare organizations within the United States were studied. RESULTS The literature review is presented in 5 sections covering the basics of defining and measuring burnout; its impact, incidence, and causes; and interventions and remediation strategies. CONCLUSIONS All US medical students, physicians in training, and practicing physicians are at significant risk of burnout. Its prevalence now exceeds 50%. Burnout is the unintended net result of multiple, highly disruptive changes in society at large, the medical profession, and the healthcare system. Both individual and organizational strategies have been only partially successful in mitigating burnout and in developing resiliency and well-being among physicians. Two highly effective strategies are aligning personal and organizational values and enabling physicians to devote 20% of their work activities to the part of their medical practice that is especially meaningful to them. More research is needed.
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Affiliation(s)
- R James Valentine
- Division of Vascular Surgery, Department of Surgery, Vanderbilt University Medical Center, Nashville, TN.
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Among Musculoskeletal Surgeons, Job Dissatisfaction Is Associated With Burnout. Clin Orthop Relat Res 2016; 474:1857-63. [PMID: 27113597 PMCID: PMC4925415 DOI: 10.1007/s11999-016-4848-6] [Citation(s) in RCA: 20] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/18/2016] [Accepted: 04/14/2016] [Indexed: 01/31/2023]
Abstract
BACKGROUND Burnout is common in professions such as medicine in which employees have frequent and often stressful interpersonal interactions where empathy and emotional control are important. Burnout can lead to decreased effectiveness at work, negative health outcomes, and less job satisfaction. A relationship between burnout and job satisfaction is established for several types of physicians but is less studied among surgeons who treat musculoskeletal conditions. QUESTIONS/PURPOSES We asked: (1) For surgeons treating musculoskeletal conditions, what risk factors are associated with worse job dissatisfaction? (2) What risk factors are associated with burnout symptoms? METHODS Two hundred ten (52% of all active members of the Science of Variation Group [SOVG]) surgeons who treat musculoskeletal conditions (94% orthopaedic surgeons and 6% trauma surgeons; in Europe, general trauma surgeons do most of the fracture surgery) completed the Global Job Satisfaction instrument, Shirom-Malamed Burnout Measure, and provided practice and surgeon characteristics. Most surgeons were male (193 surgeons, 92%) and most were academically employed (186 surgeons, 89%). Factors independently associated with job satisfaction and burnout were identified with multivariable analysis. RESULTS Greater symptoms of burnout (β, -7.13; standard error [SE], 0.75; 95% CI, -8.60 to -5.66; p < 0.001; adjusted R(2), 0.33) was the only factor independently associated with lower job satisfaction. Having children (β, -0.45; SE, 0.0.21; 95% CI, -0.85 to -0.043; p = 0.030; adjusted R(2), 0.046) was the only factor independently associated with fewer symptoms of burnout. CONCLUSIONS Among an active research group of largely academic surgeons treating musculoskeletal conditions, most are satisfied with their job. Efforts to limit burnout and job satisfaction by optimizing engagement in and deriving meaning from the work are effective in other settings and merit attention among surgeons. LEVEL OF EVIDENCE Level II, prognostic study.
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Professional burnout and its correlates in Lithuanian neurosurgeons. Acta Neurochir (Wien) 2016; 158:1437-45. [PMID: 27339267 DOI: 10.1007/s00701-016-2869-2] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/07/2016] [Accepted: 06/02/2016] [Indexed: 10/21/2022]
Abstract
BACKGROUND This study aimed to evaluate prevalence and severity of professional burnout in a sample of Lithuanian neurosurgeons and to analyze its personal, interpersonal, and organizational correlates. METHOD Thirty-one out of 79 (response rate 39 %) Lithuanian neurosurgeons participated in the study. Professional burnout was evaluated using the Maslach Burnout Inventory - General Survey. Participants also answered questions about professional stressors, sources of professional dissatisfaction, life-style factors, sickness absenteeism/presenteeism, and professional practice. RESULTS The majority of neurosurgeons were between 41 and 60 years of age (48 %), were married (97 %), had children (84 %). Most neurosurgeons had 20 or more years of professional experience (54.9 %), worked from 41 to 60 h per week (58 %), and performed up to 150 surgeries per year (77.4 %). Eight (26 %) neurosurgeons reported a high level of emotional exhaustion, five (16 %) reported high level of cynicism, and eight (26 %) reported low professional efficacy. Correlation analyses revealed that higher number of surgeries per year, more hours devoted to clinical work, opportunities for professional development, intellectual challenges at work, appreciation by the patients and prestige of the profession were related to lower level of burnout. Greater general workload, unpredictability of the work schedule, lack of necessary technical equipment, dissatisfaction with colleagues, and uncertainty about the future were related to a higher level of burnout. CONCLUSIONS Burnout was reported by one-quarter of neurosurgeons who chose to participate in the study. Personal, interpersonal, and organizational factors arising while fulfilling professional duties were important correlates of neurosurgeons' burnout. Due to the moderate response rate, our results should be interpreted with caution. Larger studies evaluating burnout among European neurosurgeons are needed.
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Elmore LC, Jeffe DB, Jin L, Awad MM, Turnbull IR. National Survey of Burnout among US General Surgery Residents. J Am Coll Surg 2016; 223:440-51. [PMID: 27238875 DOI: 10.1016/j.jamcollsurg.2016.05.014] [Citation(s) in RCA: 295] [Impact Index Per Article: 36.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/12/2016] [Revised: 05/10/2016] [Accepted: 05/17/2016] [Indexed: 01/16/2023]
Abstract
BACKGROUND Burnout is a complex syndrome of emotional distress that can disproportionately affect individuals who work in health care professions. STUDY DESIGN For a national survey of burnout in US general surgery residents, we asked all ACGME-accredited general surgery program directors to email their general surgery residents an invitation to complete an anonymous, online survey. Burnout was assessed with the Maslach Burnout Inventory; total scores for Emotional Exhaustion (EE), Depersonalization (DP), and Personal Accomplishment (PA) subscales were calculated. Burnout was defined as having a score in the highest tertile for EE or DP or lowest tertile for PA. Chi-square tests and one-way ANOVA were used to test associations between burnout tertiles for each subscale and various resident and training-program characteristics as appropriate. RESULTS From April to December 2014, six hundred and sixty-five residents actively engaged in clinical training had data for analysis; 69% met the criterion for burnout on at least one subscale. Higher burnout on each subscale was reported by residents planning private practice careers compared with academic careers. A greater proportion of women than men reported burnout on EE and PA. Higher burnout on EE and DP was associated with greater work hours per week. Having a structured mentoring program was associated with lower burnout on each subscale. CONCLUSIONS The high rates of burnout among general surgery residents are concerning, given the potential impact of burnout on the quality of patient care. Efforts to identify at-risk populations and to design targeted interventions to mitigate burnout in surgical trainees are warranted.
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Affiliation(s)
- Leisha C Elmore
- Department of Surgery, Washington University School of Medicine, St Louis, MO
| | - Donna B Jeffe
- Department of Medicine, Washington University School of Medicine, St Louis, MO
| | - Linda Jin
- Department of Surgery, Washington University School of Medicine, St Louis, MO
| | - Michael M Awad
- Department of Surgery, Washington University School of Medicine, St Louis, MO
| | - Isaiah R Turnbull
- Department of Surgery, Washington University School of Medicine, St Louis, MO.
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Dimou FM, Eckelbarger D, Riall TS. Surgeon Burnout: A Systematic Review. J Am Coll Surg 2016; 222:1230-1239. [PMID: 27106639 DOI: 10.1016/j.jamcollsurg.2016.03.022] [Citation(s) in RCA: 208] [Impact Index Per Article: 26.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/07/2016] [Revised: 03/04/2016] [Accepted: 03/11/2016] [Indexed: 10/22/2022]
Affiliation(s)
- Francesca M Dimou
- Department of Surgery, The University of Texas Medical Branch, Galveston, TX.,Department of Surgery, University of South Florida, Tampa, FL
| | - David Eckelbarger
- Department of Surgery, The University of Texas Medical Branch, Galveston, TX
| | - Taylor S Riall
- Department of Surgery, University of Arizona, Banner-University Medical Center, Tucson, AZ
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Beyond the body: A systematic review of the nonphysical effects of a surgical career. Surgery 2016; 159:650-64. [DOI: 10.1016/j.surg.2015.08.017] [Citation(s) in RCA: 49] [Impact Index Per Article: 6.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/03/2015] [Revised: 08/06/2015] [Accepted: 08/15/2015] [Indexed: 12/21/2022]
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Kang S, Jo HS, Boo YJ, Lee JS, Kim CS. Occupational stress and related factors among surgical residents in Korea. Ann Surg Treat Res 2015; 89:268-74. [PMID: 26576407 PMCID: PMC4644908 DOI: 10.4174/astr.2015.89.5.268] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/29/2015] [Revised: 06/08/2015] [Accepted: 06/16/2015] [Indexed: 11/30/2022] Open
Abstract
Purpose The application rate for surgical residents in Korea has continuously decreased over the past few years. The demanding workload and the occupational stress of surgical training are likely causes of this problem. The aim of this study was to investigate occupational stress and its related factors in Korean surgical residents. Methods With the support of the Korean Surgical Society, we conducted an electronic survey of Korean surgical residents related to occupational stress. We used the Korean Occupational Stress Scale (KOSS) to measure occupational stress. We analyzed the data focused on the stress level and the factors associated with occupational stress. Results The mean KOSS score of the surgical residents was 55.39, which was significantly higher than that of practicing surgeons (48.16, P < 0.001) and the average score of specialized professionals (46.03, P < 0.001). Exercise was the only factor found to be significantly associated with KOSS score (P = 0.001) in univariate analysis. However, in multiple linear regression analysis, the mean number of assigned patients, resident occupation rate and exercise were all significantly associated with KOSS score. Conclusion Surgical residents have high occupational stress compared to practicing surgeons and other professionals. Their mean number of assigned patients, resident recruitment rate and exercise were all significantly associated with occupational stress for surgical residents.
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Affiliation(s)
- Sanghee Kang
- Department of Surgery, Korea University College of Medicine, Seoul, Korea
| | - Hye Sung Jo
- Department of Surgery, Korea University College of Medicine, Seoul, Korea
| | - Yoon Jung Boo
- Department of Surgery, Korea University College of Medicine, Seoul, Korea
| | - Ji Sung Lee
- Department of Medical Statistics, Asan Medical Center, Seoul, Korea
| | - Chong Suk Kim
- Department of Surgery, Korea University College of Medicine, Seoul, Korea
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O'Kelly F, Manecksha RP, Quinlan DM, Reid A, Joyce A, O'Flynn K, Speakman M, Thornhill JA. Rates of self-reported ‘burnout’ and causative factors amongst urologists in Ireland and the UK: a comparative cross-sectional study. BJU Int 2015; 117:363-72. [DOI: 10.1111/bju.13218] [Citation(s) in RCA: 47] [Impact Index Per Article: 5.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/11/2022]
Affiliation(s)
- Fardod O'Kelly
- Department of Urological Surgery; Tallaght Hospital; Dublin Ireland
| | | | | | - Alex Reid
- Department of Occupational Health; Tallaght Hospital; Dublin Ireland
| | - Adrian Joyce
- The British Association of Urological Surgeons; London UK
| | - Kieran O'Flynn
- The British Association of Urological Surgeons; London UK
| | - Mark Speakman
- The British Association of Urological Surgeons; London UK
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Burnout phenomenon in U.S. plastic surgeons: risk factors and impact on quality of life. Plast Reconstr Surg 2015; 135:619-626. [PMID: 25357156 DOI: 10.1097/prs.0000000000000855] [Citation(s) in RCA: 73] [Impact Index Per Article: 8.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
BACKGROUND Recent studies by the American College of Surgeons reveal that nearly 40 percent of U.S. surgeons exhibit signs of burnout. The authors endeavored to quantify the incidence of burnout among U.S. plastic surgeons, determine identifiable risk factors, and evaluate its impact on quality of life. METHODS All U.S. residing members of the American Society of Plastic Surgeons were invited to complete an anonymous survey between September of 2010 and August of 2011. The survey contained a validated measure of burnout (Maslach Burnout Inventory) and evaluated surgeon demographics, professional and personal risk factors, career satisfaction, self-perceived medical errors, professional impairment, and family-home conflicts. RESULTS Of the 5942 surgeons invited, 1691 actively practicing U.S. plastic surgeons (28.5 percent) completed the survey. The validated rate of burnout was 29.7 percent. Significant risk factors for burnout included subspecialty, number of hours worked and night calls per week, annual income, practice setting, and academic rank. Approximately one-fourth of plastic surgeons had significantly lower quality-of-life scores than the U.S. population norm, and this risk increases in burned out surgeons. In addition to having lower career satisfaction and more work-home conflicts, plastic surgeons with burnout also had a nearly two-fold increased risk of self-reported medical errors and self-reported impairment. CONCLUSIONS Over one-fourth of plastic surgeons in the United States experience validated burnout, with concomitant attenuated career satisfaction and quality of life. Multivariate analysis identified predisposing factors that may aid in better understanding risk profiles that lead to burnout; therefore, efforts to understand and thereby avoid this burnout phenomenon are warranted.
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